Treating Adolescent Depression : A Systematic Review

Depression is a common mental health disorder, affecting more than two million adolescents in the United States each year (National Institute of Mental Health, 2015). The United States Preventive Services Task Force (USPSTF) recommends adolescents are screened for major depressive disorder (USPSTF, 2016). The purpose of this paper is to summarize a quality improvement project that implements universal adolescent depression screening in a pediatric primary clinic using Kotter’s change management theory and model for change as the framework for this process improvement.

Depression is a prominent illness in the adolescent community, and we need to find a way to help and treat sufferers of

Today schools are taking a much more effective role in detection of depression in the younger generations. Because school is like work for adults and is where children spend most of their days, I thought it would be appropriate to discuss a model developed by Urie Bronfenbrenner and Morris in 1979, which addresses the totality of the child’s life up to the present moment. This model gave school counselors a tool to work from while assessing the children. This model puts every aspect of the disorder on a continuum that professionals can use as a guide during questioning and diagnosis. Due to the fact that depression is hard to detect in young children, this process allows the counselor to see all symptoms present even if they don’t fit the DSM IV criteria to comprise a diagnosis. The Ecological Model takes a look at the child as a whole. This includes, home,

Depression is a leading cause of death among adolescents- So why aren’t we doing more about it? “Experts estimate that 5% of all adolescents will suffer from depression. Unfortunately, only 20% of depressed adolescents are appropriately diagnosed and treated” (DBSA). A depressive disorder is a disease that affects mood, thoughts and behavior. It is also the reaction of the human to the unfavorable surroundings or environment. DBSA otherwise known as Depression and Bipolar Support Alliance states, “When a bad day turns into a bad week, month or more, there may be a medical explanation for this change in behavior of feelings of hopelessness” (DBSA). Many parents may think that a young adolescent is moody or unhappy because it is a natural part of being young and growing up. However, “Persistent unhappiness or moodiness is not normal for anyone” (DBSA). If depression was better recognized, treatment was more readily available, and depressed adolescents adhered to treatment, adolescent life could be enjoyed by millions that would otherwise suffer.

Depression is one of the most commonly diagnosed psychiatric disorders among school-aged youth, with high prevalence and far-reaching consequences (Probst, 2008). “School Phobia and excessive clinging to parents may be symptoms of depression in children. Poor academic performance, substance abuse, antisocial behavior, sexual promiscuity, truancy, and running away may be symptoms of depression in adolescents” (Sadock & Sadock, 2003, p. 554). Depression in adolescents often is an unremitting disorder that predicts ongoing depression and psychosocial impairment (Kratochvil et. at., 2005). It affects the developmental process, resulting in difficulties with concentration and motivation, leading to poor academic performance,

In “Should All Teens Be Screened for Depression?”, Dr. Chung and Dr. Frances give their opinions on early diagnoses on teenagers, be them supporting the concern, or disagreeing. Chung explains how screening for depression at an earlier time is crucial for effective treatment. Chung also describes the statistics of how 1 in 12 teenagers between ages 12 to 17 are affected with the mental illness, but only less than half are properly diagnosed. He justifies that it is up to clinicians to hold these critical conversations about this mental ailment. However, Allen Frances argues that a diagnosis for depression is too risky. Frances contends that misdiagnoses are all too common, and happen way too often. He clearly indicates

Both the U.S. Preventive Services Task Force (USPSTF) (2016) and the American Academy of Pediatrics (AAP) (2014) recommend depression screening of all adolescent patients 12 to 18 years of age. As Zenlea, Milliren, Mednick, & Rhodes (2014) made evident, this is not the case in most office-based practices in the United States. Although this study took place prior to the release of current recommendations, the last recommendations in 2009 by the USPSTF was to screen all of those at risk, as long as there were systems in place to help those at risk. Zenlea, Milliren, Mednick, & Rhodes (2014) concluded that adolescent screening for depression across the United States

Studies that evaluate universal school-based programs, have been known to provide effectiveness in determining proper treatments (Tomyn, Tyszkiewicz, Richardson, and Colla, 2016). Up to 50% of all depression cases had signs in their adolescence. (Kessler et al.,2007 as cited in Tomyn et al., 2016) Depression is a problem world-wide. In many cases people are not treated for depression until adulthood making it more difficult (Gladstone and Beardslee 2009). The purpose of universal interventions is to gain knowledge to strengthen protective factors and reduce risk factors (Tomyn et. al.,2016). In this study, they are trying to measure how the program will positively or negatively affect adolescents. As well as to see the effectiveness of the program for adolescents already experiencing symptoms of depression (Tomyn et al.,2016).

The “Adolescent Depression Knowledge Questionnaire” was administered to 4,299 students as a pretest for the program. Two years later, they took the same test to evaluate the effectiveness of it. Although the study was deemed inconclusive due to some of tests being lost in the mail as well as the number of absences at school, there was a small test grade increase between the pretests and posttests. However, this number was not statistically significant (Cox et al., 2007). Since the primary intervention aims to prevent the disease before it occurs, being equipped with knowledge through these programs would be the most effective tool in decreasing risks of

Depression is a prodigious issue in today’s society and is especially prevalent in teens. According to teen depression statistics, around 20% of teens have or are currently experiencing depression symptoms. And that doesn’t include self- harm or suicide/attempted suicide. Because depression is becoming such a major issue, antidepressant prescription has skyrocketed; but is it really doing what it should? If antidepressant use is increasing, why are the numbers of depressed teens growing or remaining the same? I believe that though antidepressants can be helpful in some cases, they tend to cause more side effects and problems in the long run. Alternative options have been proven to work just as well without the incredibly surprising and potentially serious side effects of antidepressant drugs.

Depression has become a daunting problem around the world, with the World Health Organization listing it as the leading cause of disability.1 As well, in 2030 it is anticipated to be second on a list of fifteen major disease burdens.2 In the United States, depression is a large, but often overlooked epidemic. It is estimated that 6.7% of the U.S. population suffer from depression yearly, with a lifetime diagnosis rate of approximately 16%.3,4 Additionally, it is estimated that 4-5% of adolescents are suffering from depression each year, with a lifetime prevalence rate of 11.7% in youth aged 13 to 18.5,6 Although 60-90% of adolescent episodes last one year or less, 50-70% percent are expected to relapse within 5 years.5

It was also noticed that there was impairment in the ability to function in school and in interpersonal relationships. According to Pine, Cohen, Cohen and Brook’s study (as cited in Technow, Hazel, Abela, and Hankin), “minor depression in youth represents a significant risk factor for major depression in adulthood.” This led to a study on depression in adolescence. The hypothesis was that there is an interaction between the history of depression and the stress and that these could be used to predict depressive symptoms in youth. The study was then divided into two phases. The first phase was a baseline laboratory assessment. Research assistants met with parents of the adolescents being tested. The parents completed a demographics questionnaire and were asked to give their annual familial income on a scale of one to eight in $15,000 increments. Phase two of the study was based on eight telephone follow-up assessments. Each of the eight times, the CDI (Children’s Depression Inventory) and the ALEQ (Adolescent Life Events Questionnaire) was given verbally. Only at the six-, twelve-, eighteen-, and twenty four- month assessment was the K-SADS (Schedule for Affective Disorders and Schizophrenia for School-Age Children) given. The study was ended after the last assessment in the two year

Funded by the National Institute of Mental Health, improvements in the treatment of depression in adolescents were evaluated within the Treatment for Adolescents with Depression Study (TADS). Using a randomized controlled sample, the effectiveness of three active treatments for adolescents experiencing major depression were evaluated throughout three stages (e.g. acute, consolidation, and continuation treatment): clinical management with fluoxetine, cognitive-behavioral therapy (CBT), the combination of fluoxetine and cognitive behavioral therapy (CBT) together, and clinical management with a placebo medication as a control condition. One year of naturalistic follow-up succeeding the completion of treatment was conducted as well. This article will be instrumental in the focus of major depression treatment and its associated

The majority of the literature reviewed had a similar consensus that the prevalence and risk factors associated with adolescent depression are a common problem worldwide. In a longitudinal study in Sweden, Wirback, Moller, Larsson, Galanti, and Engstrom (2014) examined whether multiple measures of low social status of the family are longitudinally associated with depressive symptoms in adolescence and whether or not there is a difference among genders. A total of 1880 adolescents in Sweden, self-reported their depressive symptoms by utilizing a 12-item inventory survey (Wirback et al., 2014). The study found that there is an increased risk of depression among adolescents whose parents has low education, were unskilled workers, intermediate non-manual workers or self-employed, compared to parents with higher education and high non-manual work (Wirback et al., 2014). There was also an increased (tripled) risk of depression among adolescents living with only one parent. In regards to gender differences, there was a higher risk for girls whose parents are low-educated or girls that were living with only one parent are especially vulnerable (Wirback et al., 2014). Overall, social factors does have a huge impact on the risk of adolescent depression, thus continued work is needed to reduce inequalities in depressive symptoms.

People used to believe that children had no reason to be depressed it wasn’t till a few years ago: “No one thought that children could suffer from real depression; there wasn’t even an official diagnosis for childhood depression until 1980” (Fassler 4). But really who would have thought that such a thing could be possible. Sadly today we know that it’s a real disease and it affects more adolescents than we think: “ The National Institute of Mental Health estimates that as many as 2.5 percent of all American youngsters under the age of eighteen or over 1.5 million children and adolescents are seriously depressed” (Fassler 2).